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A <br /> Official Use <br /> Admin Traffic Police Fire Transit Streets <br /> Approved: <br /> Rejected: <br /> Special Conditions: <br /> Comments: <br /> Council agenda date: / / City Council approval: _/ / <br /> Permit TR# <br /> Acknowledgement of Conditions & Certification <br /> As a material consideration to the City granting this approval, and without which the City would not <br /> do so, Applicant agrees to and does hereby indemnify and hold the City, its officers, employees and <br /> agents harmless from and against any and all claims, actions, demands, suits, losses or liability <br /> resulting at any time from injury to or death of any person or persons, and or damage to any and all <br /> property occurring or arising from this approval, or resulting from any non-compliance with any <br /> law, ordinance or regulation respecting the performance of approval granted herein, or otherwise <br /> arising or resulting from the approval granted. With limiting the generality of the foregoing,the <br /> within indemnification by Applicant of City, its officers, employees and agents shall include <br /> indemnification from any claim, action, demand, cause of action, suit, or proceeding, and said <br /> indemnification shall in all events include any and all attorney's fees, court costs and other legal <br /> expenses, and shall include the obligation of Applicant to appear in and defend any and all such <br /> claims, actions, or other legal proceedings whether judicial, quasi-judicial, administrative or <br /> otherwise, against or affecting City, its officers, employees and agents arising out of or pertaining to <br /> the approval granted herein. This paragraph does not purport to indemnify the City, its officers, <br /> employees and agents against liability for damages arising out of bodily injury to persons or <br /> damages caused by or resulting from the sole negligence or willful misconduct of the City, its <br /> officers, employees or agents acting within their scope of employment.Also, as Applicant I certify <br /> that the information provided on this application is true and correct. <br /> CO August 10, 2007 <br /> Signature Dat <br /> Anne M. Trice, I /OLPH Booster Club Executive Board Secretary <br /> Printed Name <br /> IC/OLPH School Booster Club 425-388-3396 (w) OR 425-343-6843(H) <br /> Organization Representing Phone No. <br /> 7 <br />